AB163. SOH21AS160. May-Thurner syndrome: a case series—is the incident as low as we think?
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AB163. SOH21AS160. May-Thurner syndrome: a case series—is the incident as low as we think?

Olivia Baird1, Alison Bell2, Aisling Egan1, Peter Staunton3, Michael Watts1, Eamonn Kavanagh1,4

1Department of General Medicine, University Hospital Limerick, Limerick, Ireland; 2Department of Anaesthetics, University Hospital Limerick, Limerick, Ireland; 3Department of Orthopaedics, University Hospital Limerick, Limerick, Ireland; 4Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland

Background: May-Thurner syndrome (MTS) is an uncommon condition leading to venous outflow obstruction resulting from extrinsic venous compression by the arterial system against bony structures. The prevalence of MTS was thought to be rare when first described, and even today the incidence is still relatively unknown. It is thought that MTS causes only between 2–5% of deep vein thrombosis (DVT), but its prevalence may be widely underestimated. We present three cases of MTS with DVT, all with differing risk factors.

Methods: Three patients presented to University Hospital Limerick (UHL) with acute onset unilateral left leg swelling and pain. MTS was an incidental finding in two of the cases following CT. Two patients were managed medically with anticoagulation. They both re-presented with pain and no improvement in swelling, and were treated with catheter-directed thrombolysis (CDT). The third patient was sent for thrombolysis immediately. They are all pending investigation for venous insufficiency post-discharge.

Results: In cases of DVT or pulmonary embolism, patients can often be diagnosed and treated without further investigation, particularly if they have risk factors for the same. If there is high suspicion of MTS, additional imaging should be undertaken. In MTS with DVT, recommended management is therapeutic anticoagulation, CDT and ultrasound. If anticoagulation alone is used, studies have shown that patients respond poorly, as seen in our cases.

Conclusions: We hope to highlight that the prevalence of MTS may be much higher than anticipated, and that identification of the pathology may alter the management in DVT presenting with minimal risk factors.

Keywords: Anticoagulation; catheter-directed thrombolysis (CDT); deep vein thrombosis (DVT); May-Thurner syndrome (MTS); venous outflow obstruction


Funding: None.


Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-21-ab163
Cite this abstract as: Baird O, Bell A, Egan A, Staunton P, Watts M, Kavanagh E. SOH21AS160. May-Thurner syndrome: a case series—is the incident as low as we think? Mesentery Peritoneum 2021;5:AB163.

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